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Providing telemedicine to the corrections industry

Telemedicine has been gaining momentum as an efficient and cost effective option for healthcare within a diverse variety of industries including corrections. Given the unique environment of a correctional facility, there is potential for a range of telemedicine applications from consultations to emergency support. PRAXES’ Doctor Donald Fay has been working with Southwest Nova Scotia Correctional Facility in Yarmouth for approximately ten years providing weekly consultations regarding inmates. Fay also operates his own family practice in Halifax and has twenty years of experience working with patients dealing with addictions. With a background as a control systems engineer, he also has a special interest in biomedical engineering and medical records. Dr. Fay answered a few questions for us on the unique nature of his ongoing work in corrections.

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Can you describe what your position with PRAXES entails?

PRAXES has a contract with Southwest Nova Scotia Correctional Facility to provide three consultations per week working with a nurse who meets with the inmates in person. Every Monday, Wednesday and Friday, I have a phone consultation with the nurse who will have a list of inmates to discuss who have been in her clinic that day. We go over the different cases in detail and the medications that might be needed.

In your opinion, what are some of your biggest challenges in regards to working remotely?

From my perspective, participating in our phone consultations is like listening to the radio. You have this idea in your mind and a person is being described to you but you’re not actually seeing them. My ears and eyes are the nurse because she does see the inmates and listens to them and has a very good sense of their character. I see through her eyes and she is excellent at seeing what is in front of her. In terms of the medications, there are very strict rules and narcotics are very rarely prescribed. I’m not able to prescribe narcotics to the inmates but I do know how to taper and get people off these drugs.

Can you give us any examples of the types of medical incidents that you treat in corrections?

There are many psychiatric conditions such as depression, anxiety disorders and personality disorders that arise. Often these issues are initially in the background for inmates and then come to the foreground. A broad spectrum of psychiatric and personality presentations are there, along with the manipulations that occur in terms of inmates trying to get certain things. In that department, Debbie, our nurse, is fantastic. She is able to diagnose these situations very quickly and I often formulate the same impression as she describes them on the phone without the advantage of seeing that person. Her descriptions for me are so clear and she very carefully and succinctly describes each situation.

You have a great deal of experience working with patients battling addictions and you also have a background as an electrical engineer. Do these unique skills come into play in your role with PRAXES?

My sub-branch within electrical is as a control systems engineer so I’m interested in systems and how they work. The technology I’m using for Southwest Nova is straight-forward but I’m interested in human communications as well as communications that may be in place to deliver something at the other end. It happens to be humans that we’re working with rather than missiles or space vehicles, and I find that very intriguing.

Over the last twenty years, I have also had quite a bit of experience in treating drug addiction. Many people with drug addictions have had very rough lives and have criminal records. I’ve had a lot of exposure to this population and a high percentage of the inmates at Southwest Nova have similar demeanours, attitudes and approaches to those of my patients with addictions issues. It was about ten years ago when methadone was approved as a treatment component in opiate addiction and previous to that we didn’t really have an effective option. I was one of the few private practitioners to get a methadone license and we were finally able to treat opiate addictions. We couldn’t do that effectively before the introduction of methadone. I think that this experience helps me in regards to my work with PRAXES. I can connect right away with the nurse’s description of her clients at Southwest Nova and the conversations resonate with me.

Do you think that telemedicine is an effective option for healthcare within corrections?

The work I’m doing with the facility in Yarmouth only involves the telephone and a fax machine but if you look at the telemedicine technology that is available and how cost effective it is, we could easily treat many patients through the audio-visual tools that are available. However, I don’t believe in applying technology for the sake of applying technology. Sometimes all you need is the telephone, which is what we’re doing with the corrections facility at this time – and it’s very effective.

One of the advantages to our system is that there’s only been one week in ten years, that I have not participated in our consultations. No matter where I am in the world, through the internet I can connect to my server in my office and have secure access to everything I need. The technology that we’re using really allows me to go anywhere. In terms of telemedicine, that’s an area that’s just going to expand because there’s so much potential there in terms of interactive consultations, distant physical examinations with cost effective electronics, and connectivity with provincial resources. The technology is available today and is at the right price.

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